MCCQE I (PART 1) Graded A+

Pt is competent and agrees to a procedure but his proxy refuses, what do you do ? - ANSWER-Do procedure, PT is competent and overrides the proxy CPSS (Canadian perinatal surveillance system) - ANSWER-Abuse during preggy results in poor fetal and maternal outcome Violence was measured on the basis of the conflicts tactics scale low birth weight and early birth Pt O/D on opiates, what should you set up before discharge? - ANSWER-Next day meeting with her own PCP MCC hearing loss in children? - ANSWER-Bacterial meningitis Lady with HTN on CCB, what side effect can she have? - ANSWER-Galactorrhea....PRL Referral to an audiologist in child when: - ANSWER-No babbling sound by 12 no rxn to sound by 3 months no resposne to smiles or interactions by 6 months no single words by 16 months no two word phrases by 24 months speech hard for strangers to understand no following of directions by 4-5 years In terms of breast masses, what would you think of a coarse popcorn type calcification - ANSWER-Not malignant, most likely fibroadenoma What are scary calcifications to see? - ANSWER-Microcalcifications less than 0.5 mm in size fine or branching Wing scapula after mastectomy - ANSWER-LTN Tamoxifen effect on osteoporosis? Side effects? - ANSWER-In breast it's an antagonist of ER, elsewhere it is an agonist of ER: osteoprotective Increases risk of DVT, endometrial carcinoma, hot flushes increased risk of CATARACTS When to use Tamoxifen vs Anastrozole - ANSWER-before and after menopause ovary vs fat estrogen (aromatase) What receptor is a negative prognostic factor in breast Ca? - ANSWER-HER-2/neu ER is a positive prognostic factor Mild vs severe preecclampsia difference? - ANSWER-Severe has pulmonary edema, fetal growth restrictions, thrombocytopenia, headache, abd pain, visual changes (basically severe has Sx`s whereas mild is detected only by tests) What risk factors increase the risk of preeclampsia? - ANSWER-chronic HTN, twin gestation, maternal age 35+, obesity, AA ethnicity, socioeconomical status, nulliparity Cause of urinary incontinence in multiple sclerosis? Rx? - ANSWER-Detrusor muscle hyperactivity Give oxybutynin and bladder training Pt in accident with full bladder, urine seen in peritoneumÉ where was injury? - ANSWER-Dome or anterior wall of bladder (they are covered by peritoneum) 9-12 month old kid with fever then erythrematous maculopapular rash, 15% of them have febrile seizure,Dx? Rx? - ANSWER-Roseola infantum HHV-6/ 6th disease Rx is supportive, no serious sequelae Conjunctivitis and coryzea with rash on face: - ANSWER-Measles-----Give VitA Possible rare complication? Subacute sclerosing panencephalitis What is erythrema infectiosum? - ANSWER-Fifth disease of slapped cheek appearance (ParvoB19) Also remember the school teacher with joint pains Aplastic crisis possible Moderate acute radiation dermatitis results form what? (itching skin rash and burning pain with sloughing off of epithelium and vesicle formation) How do you prevent it? How do you treat this? - ANSWER-Exposure of subdermal lymphatics Intensity modulate radiation therapy Gentle washing with soapy water BRCA 1 positive risk of ovarian and breast? - ANSWER-Breats Ca 65%, ovarian Ca 40% do total mastectomy and oophorectomy How long after ACL repair (using tissue to repair) do you have to wait to return to normal activity? - ANSWER-6 months Remember Lachman test and anterior drawer signs - ANSWER-30-40 flexion laying back Ant drawer sign: 6mm+ traction = positive If both these are positive then MRI not necessary to make Dx ***** Acute gout DOC between indomethacin and colchicine^ - ANSWER-Indomethacin (NSAIDs) which of the following is NOT a risk factor for gout? Obesity etOH rich meat diet HCTZ Smoking low dose ASA - ANSWER-Smoking Allopurinol and probenecid MOA ? - ANSWER-Allopurinol: decreases production (XO inhibitor), use in tumor lysis syndrome!! Probenecid: increases excretion ....must have good creatinine clearance How do you confirm the Dx of molluscum contagiosum if clinically uncertain? - ANSWER-Curette and histopathology Rx:usually reassure and wait Preterm labor what do you give (3) ? - ANSWER-Tocolytics (CCB, indomethacin or Mag) Penicillin Glucocorticoids Most common cause of preterm labor? - ANSWER-idiopathic Name common side effects for Mag Sulfate used in preterm labor? - ANSWER-Respiratory depression cardiac arrest blurred vision flushing nausea headache HBV in mom, how do you treat her and kid? - ANSWER-HBIG for mom during pregnancy HBIG and vaccine at birth for child Side effect of trimpethoprim (electrolyte)? - ANSWER-Hyperkalemia Elevated LDH is present in both PCP and histoplasmosis - ANSWER- PRophylaxis vs Rx for PCP? - ANSWER-Bactrim